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Two-Stage Cervical and Thoracic-Lumbar-Sacral Circumferential Fixation for Pyogenic Spondylitis: A Case Report – Lumbar Fusion

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The article discusses a case study of an 84-year-old man with pyogenic spondylitis affecting multiple regions of the spine. Despite conservative treatment with antibiotics, the patient’s condition worsened, leading to neurological symptoms and ambulation disturbances. Eventually, surgical intervention was required, and the patient underwent two-stage surgeries including anterior cervical discectomy and fusion, posterior cervical fixation, and lumbar intervertebral fusions with long-level fixation. The surgeries were successful, and the patient’s condition improved, allowing him to ambulate independently. This case highlights the effectiveness of two-stage cervical and thoracic-lumbar-sacral circumferential fixation for refractory cases of pyogenic spondylitis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spinal hospital in London

Published article

Pyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage in the following management, cervical and thoracic-lumbar-sacral circumferential fixations in two sessions for pyogenic spondylitis have not been previously…

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Cureus. 2024 Jan 27;16(1):e53070. doi: 10.7759/cureus.53070. eCollection 2024 Jan.ABSTRACTPyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage,

Cureus. 2024 Jan 27;16(1):e53070. doi: 10.7759/cureus.53070. eCollection 2024 Jan.

ABSTRACT

Pyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage in the following management, cervical and thoracic-lumbar-sacral circumferential fixations in two sessions for pyogenic spondylitis have not been previously described. An 84-year-old man complained of ambulation disturbances and pain in the neck and upper and lower extremities (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 5/17). Magnetic resonance imaging revealed pyogenic spondylitis of the cervical, thoracic, and lumbar regions. Epidural abscesses and spondylodiscitis were concurrently diagnosed with multi-level skipping lesions from the cervical to the sacral regions. As these lesions were resistant to antibiotic treatment and the neurological symptoms worsened, surgical treatment was planned. Anterior cervical discectomy and fusion, and posterior cervical fixation were followed by oblique and posterior lumbar intervertebral fusions with long-level fixation from T12 to the ilium using percutaneous pedicle screws. The surgeries were performed in two sessions to avoid the invasiveness of surgeries in a single session. The patient’s condition improved after a second surgery. The patient was discharged on postoperative day 116. No recurrence was observed for six months, and the patient was able to ambulate independently. Two-stage cervical and thoracic-lumbar-sacral circumferential fixation for pyogenic spondylitis contributed to a favorable outcome (the Japan Orthopaedic Association cervical myelopathy evaluation questionnaire score of 13/17).

PMID:38410351 | PMC:PMC10896660 | DOI:10.7759/cureus.53070

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Two-Stage Cervical and Thoracic-Lumbar-Sacral Circumferential Fixation for Pyogenic Spondylitis: A Case Report

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Cureus. 2024 Jan 27;16(1):e53070. doi: 10.7759/cureus.53070. eCollection 2024 Jan.ABSTRACTPyogenic spondylitis is a rare life-threatening condition. Conservative treatment with antibiotics is indicated; however, surgery can be considered in refractory cases. The surgical strategy varies, as pyogenic spondylosis can occur from the cervical to sacral regions. To our knowledge, although there is less invasiveness as an advantage

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